Individual
COURTNEY CLARK FISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-3420
(570) 808-7762
(570) 808-6128
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA057988
PA
363AM0700X
Medical Physician Assistant
MA057988
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
471427
MEDICARE
PA
Enumeration date
11/08/2015
Last updated
11/28/2020
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